Healthcare Provider Details

I. General information

NPI: 1023843208
Provider Name (Legal Business Name): DR. JOSIANE ORNELLA DEGUENON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 TIETON DR
YAKIMA WA
98902-3836
US

IV. Provider business mailing address

1104 TIETON DR
YAKIMA WA
98902-3836
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-5750
  • Fax:
Mailing address:
  • Phone: 617-513-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10057346
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70137198-NP
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70137198-NP
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10057346
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: